MRI detection of early blood-brain barrier disruption - Parenchymal enhancement predicts focal hemorrhagic transformation after thrombolysis
MRI detection of early blood-brain barrier disruption - Parenchymal enhancement predicts focal hemorrhagic transformation after thrombolysis
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DOI：
10.1161/strokeaha.107.497719
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发表时间：
2008-03-01
期刊：
影响因子：
8.3
通讯作者：
Ostergaard, Leif
中科院分区：
文献类型：
--
作者：
Hjort, Niels;Wu, Ona;Ostergaard, Leif
背景与目的-血脑屏障破坏可能是缺血性卒中出血性转化（HT）的预测因子。我们假设对比后t1加权MRI的实质增强（PE）可以预测和定位随后的HT。方法：在一项前瞻性研究中，33例接受tpa治疗的脑卒中患者在溶栓治疗前、治疗后2小时和24小时分别采用灌注加权成像、T1和FLAIR成像。结果：32例患者中有5例（16%）在溶栓后2小时出现对比后T1 PE。5例患者均出现HT，而26例未出现PE的患者中有11例出现HT (P = 0.043，特异性100%，敏感性31%)，PE和HT的解剖位置准确。另外4例患者脑脊液FLAIR增强，其中1例发展为HT。5例PE患者中4例发现局部再灌注，而所有脑脊液高灌注病例均发现再灌注。结论：溶栓治疗后2小时检测PE预测HT具有高特异性。对比增强MRI可能为研究HT和靶向未来治疗提供工具，以降低出血性并发症的风险。
Background and Purpose - Blood-brain barrier disruption may be a predictor of hemorrhagic transformation (HT) in ischemic stroke. We hypothesize that parenchymal enhancement (PE) on postcontrast T1-weighted MRI predicts and localizes subsequent HT.Methods - In a prospective study, 33 tPA-treated stroke patients were imaged by perfusion-weighted imaging, T1 and FLAIR before thrombolytic therapy and after 2 and 24 hours.Results - Postcontrast T1 PE was found in 5 of 32 patients (16%) 2 hours post-thrombolysis. All 5 patients subsequently showed HT compared to 11 of 26 patients without PE (P = 0.043, specificity 100%, sensitivity 31%), with exact anatomic colocation of PE and HT. Enhancement of cerebrospinal fluid on FLAIR was found in 4 other patients, 1 of which developed HT. Local reperfusion was found in 4 of 5 patients with PE, whereas reperfusion was found in all cases of cerebrospinal fluid hyperintensity.Conclusions - PE detected 2 hours after thrombolytic therapy predicts HT with high specificity. Contrast-enhanced MRI may provide a tool for studying HT and targeting future therapies to reduce risk of hemorrhagic complications.